Key result
Study protocol outlines assessing RFA for AVNRT on patient-reported utilities and medical care use.
Why the study?
The cost-effectiveness of radiofrequency catheter ablation for drug-refractory AVNRT has not been established and depends on its impact on patient quality of life and preferences.
Does radiofrequency catheter ablation improve patient-reported utilities, symptoms, and medical care use in patients with drug refractory atrioventricular nodal reentrant tachycardia?
Observational
Does radiofrequency catheter ablation improve patient-reported utilities, symptoms, and medical care use in patients with drug refractory atrioventricular nodal reentrant tachycardia?
This study aims to evaluate the impact of radiofrequency catheter ablation on quality of life, symptoms, and healthcare utilization in patients with drug-refractory AVNRT.
AVNRT predominance in SVT holds in contemporary cohorts; confirms prior estimates but leaves open evolving incidence and triggers.
Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of supraventricular tachycardia. 1 Ganz L.I. Friedman P.L. Supravntricular tachycardia. N Engl J Med. 1995; 332: 162-173 Crossref PubMed Scopus (166) Google Scholar , 2 Orejarena L.A. Vidaillet H. DeStefano F. Nordstrom D.L. Vierkant R.A. Smith P.N. Hayes J.J. Paroxysmal supraventricular tachycardia in the general population. J Am Coll Cardiol. 1998; 31: 150-157 Abstract Full Text Full Text PDF PubMed Scopus (295) Google Scholar While rarely life-threatening, 3 Wang Y. Scheinman M.M. Chien W.W. Cohen T.J. Lesh M.D. Griffin J.C. Patients with supraventricular tachycardia presenting with aborted sudden death incidence, mechanism and long-term follow-up. J Am Coll Cardiol. 1991; 18: 1711-1719 Abstract Full Text PDF PubMed Scopus (115) Google Scholar AVNRT is a frequent cause of symptoms and occasional disability. 1 Ganz L.I. Friedman P.L. Supravntricular tachycardia. N Engl J Med. 1995; 332: 162-173 Crossref PubMed Scopus (166) Google Scholar , 4 Wood K.A. Drew B.J. Scheinman M.M. Frequency of disabling symptoms in supraventricular tachycardia. Am J Cardiol. 1997; 79: 145-149 Abstract Full Text Full Text PDF PubMed Scopus (90) Google Scholar , 5 Hamer M.E. Blumenthal J.A. McCarthy E.A. Phillips B.G. Pritchett E.L.C. Quality-of-life assessment in patients with paroxysmal atrial fibrillation or paroxysmal supraventricular tachycardia. Am J Cardiol. 1994; 74: 826-829 Abstract Full Text PDF PubMed Scopus (89) Google Scholar Medical therapy has been reasonably successful in preventing frequent paroxysms, but drug side effects may impair patient quality of life. Radiofrequency catheter ablation (RFA) of the slow pathway of the atrioventricular node has revolutionized the clinical approach to AVNRT. 6 Jackman W.M. Beckman K.J. McClelland J.H. Wang X. Friday K.J. Roman C.A. Moulton K.P. Twidale N. Hazlitt H.A. Prior M.I. Oren J. Overholt E.D. Lazzara R. Treatment of supraventricular tachycardia due to atrioventricular nodal reentry by radiofrequency catheter ablation of slow-pathway conduction. N Engl J Med. 1992; 327: 313-318 Crossref PubMed Scopus (1047) Google Scholar , 7 Manolis A.S. Wang P.J. Estes N.A.M. Radiofrequency catheter ablation for cardiac tachyarrhythmias. Ann Intern Med. 1994; 121: 452-461 Crossref PubMed Scopus (60) Google Scholar Leading centers have reported high procedural success rates, 8 Hindricks G. Multicentre European Radiofrequency Survey (MERFS) Investigators of the Working Group on Arrhythmias of the European Society of CardiologyThe Multicentre European Radiofrequency Survey (MERFS) complications of radiofrequency catheter ablation of arrhythmias. Eur Heart J. 1993; 14: 1644-1653 Crossref PubMed Scopus (464) Google Scholar , 9 Scheinman M.M. NASPE survey on catheter ablation. NASPE policy statement. PACE. 1995; 18: 1474-1478 Crossref Scopus (162) Google Scholar , 10 Calkins H. Yong P. Miller J.M. Olshansky B. Carlson M. Saul J.P. Huang S.K.S. Liem L.B. Klein L.S. Moser S.A. Bloch D.A. Gillette P. Prystowsky E. Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction. Final results of a prospective, multicenter clinical trial. Circulation. 1999; 99: 262-270 Crossref PubMed Scopus (580) Google Scholar and favorable effects of RFA on symptom frequency and quality of life. 11 Bubien R.S. Knotts-Dolson S.M. Plumb V.J. Kay G.N. Effect of radiofrequency catheter ablation on health-related quality of life and activities of daily living in patients with recurrent arrhythmias. Circulation. 1996; 94: 1585-1591 Crossref PubMed Scopus (222) Google Scholar , 12 Brignole M. Gianfranchi L. Menozzi C. Bottoni N. Bollini R. Lolli G. Oddone D. Gaggioli G. Influence of atrioventricular junction radiofrequency ablation in patients with chronic atrial fibrillation and flutter on quality of life and cardiac performance. Am J Cardiol. 1994; 74: 242-246 Abstract Full Text PDF PubMed Scopus (184) Google Scholar , 13 Lau C. Tai Y. Lee P.W.H. The effects of radiofrequency ablation versus medical therapy on the quality-of-life and exercise capacity in patients with accessory pathway-mediated supraventricular tachycardia a treatment comparison study. PACE. 1995; 18: 424-432 Crossref Scopus (45) Google Scholar The hospital charges and physician fees for RFA are >$15,000, however, 14 Kalbfleisch S.J. Calkins H. Langberg J.J. El-Atassi R. Leon A. Borganelli M. Morady F. Comparison of the cost of radiofrequency catheter modification of the atrioventricular node and medical therapy for drug-refractory atrioventricular node reentrant tachycardia. J Am Coll Cardiol. 1992; 19: 1583-1587 Abstract Full Text PDF PubMed Scopus (64) Google Scholar and its cost-effectiveness has not been established. The potential cost-effectiveness of RFA will depend largely on its effect in improving patient utility, a global measure of quality of life, and patient preferences. The present study assesses the impact of RFA on patient-reported utilities, symptoms, and medical care use in a population-based sample.
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Larson et al. (1999) conducted an observational in Drug refractory atrioventricular nodal reentrant tachycardia (AVNRT). Radiofrequency catheter ablation (RFA) was evaluated on Patient-reported utilities, symptoms, and medical care use. The abstract describes the rationale and objectives for assessing radiofrequency catheter ablation in AVNRT but does not report any quantitative results.
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